In the 20-to-39 age group, the risk of cardiovascular death for persons with Type I diabetes was more than fivefold higher in men and sevenfold higher in women than in the general population, says a report in the February issue of Stroke.
The finding is "not entirely surprising," says Susan P. Laing, an epidemiologist at the Institute of Cancer Research in England, who led the study. But while previous studies have documented the increased risk among people with Type II diabetes, in which the body produces some insulin, this is the first study to produce hard numbers about the risk of cardiovascular death in young people with Type I diabetes, she says.
"Physicians need to be much more aware that young diabetics will be having more cardiovascular risk than the general population," Laing says.
The subject already is of concern to the American Diabetes Association, says Dr. Francine R. Kaufman, an endocrinologist at Children's Hospital in Los Angeles who is president of the association.
"Just last week at a postgraduate course I said that it is important to start to look at cardiovascular risk factors at adolescence or even earlier," Kaufman says.
The association has put together an expert panel to consider recommendations about lipids such as cholesterol in Type I diabetes patients 12 and older, she says.
"Physicians need to be sure that the levels are normal," Kaufman says. "If not, they should consider intervention, such as lipid-lowering agents."
Another risk factor of special concern in young people is high blood pressure, she says, although there also is the need to monitor and intervene in the case of other risk factors, such as smoking.
"The risk begins earlier than has been thought, and we need to do good intervention in this cohort," Kaufman says.
The British study, called the Diabetes UK Cohort, included 23,751 patients diagnosed with Type I diabetes under the age of 30. The researchers followed the patients for an average of 17 years, recording deaths from stroke, heart attacks, and other cardiovascular diseases and comparing the rate of their occurrence with that of the general population.
In all, cardiovascular disease accounted for 4 percent of all deaths under the age of 40 and 8 percent over the age of 40 -- much higher than among people without diabetes.
"These observations emphasize the vital need to identify and treat known cardiovascular disease factors in young people with diabetes," Laing says.